长尾Raoultella以前被认为是土壤中的环境生物,水,和植物。然而,最近报道了几例人感染与R.planticola有关的病例,其中一些已经危及生命。大多数病例是免疫力下降的成年人,很少有儿童病例。据我们所知,仅有两例报告的儿童由R.planticola引起的尿路感染(UTI),包括一例膀胱炎。这里,我们介绍了1例4个月大男婴中由R.planticola引起的尿路感染并伴有先天性肾脏和泌尿道异常(CAKUT)。患者因发烧被送往急诊科,并被诊断为UTI。我们开始使用第三代头孢菌素对尿液中的革兰氏阴性菌进行经验性治疗,假设感染了大肠杆菌。在第1天,患者的发烧立即消退。第2天,尿液培养对一种罕见病原体呈阳性,R.planticola,我们把抗生素缩小到第一代头孢菌素。患者的发烧没有复发,他在第7天出院。患者出院1周后在门诊就诊,症状完全解决。出院后2个月进行的磁共振尿路造影和动态肾脏闪烁显像显示严重的双侧肾积水和右肾尿流阻塞。UTI发病后6个月,我们继续使用低剂量头孢氨苄(10mg/kg)来预防UTI的复发,但没有复发.在这种情况下,由R.planticola引起的UTI儿童可能与CAKUT有关;因此,我们应该积极筛查以检测CAKUT。CAKUT患者UTI复发的风险很高,因此,应避免长期使用不必要的广谱抗生素,以防止抗生素耐药性。然而,R.planticola感染有时会危及生命。因此,在适当的时期使用足够强的抗生素也很重要。尽管尚未明确确定儿童中R.planticola感染的最佳管理,我们建议我们可以主要使用第一代头孢菌素治疗由R.planticola引起的UTI。
Raoultella planticola was previously considered an environmental organism in soil, water, and plants. However, several cases of human infection have recently been reported in association with R. planticola, some of which have been life-threatening. Most cases were in adults with reduced immunity, with few cases in children. To our knowledge, there have only been two reported cases of urinary tract infection (UTI) caused by R. planticola in children, including one
case of cystitis. Here, we present the first
case of UTI caused by R. planticola with congenital anomalies of kidney and urinary tract (CAKUT) in a 4-month-old male infant. The patient presented to the emergency department with fever and was diagnosed with UTI. We started third-generation cephalosporins empirically for gram-negative bacteria in the urine, presuming infection with Escherichia coli. On day 1, the patient\'s fever resolved immediately. On day 2, urine culture was positive for a rare pathogen, R. planticola, and we narrowed antibiotics to first-generation cephalosporins. The patient\'s fever did not return and he was discharged on day 7. The patient was seen in the clinic 1 week after discharge, with complete resolution of symptoms. Magnetic resonance urography and dynamic renal scintigraphy performed 2 months after discharge revealed severe bilateral hydronephroureter and obstruction of urine flow in the right kidney. As of 6 months after UTI onset, we have continued low-dose cephalexin (10 mg/kg) to prevent the recurrence of UTI and there has been no recurrence. As in this
case, children with UTI caused by R. planticola may be associated with CAKUT; therefore, we should actively screen to detect CAKUT. Patients with CAKUT are at high risk of UTI recurrence, so long-term use of unnecessary broad-spectrum antibiotics should be avoided to prevent antimicrobial resistance. However, R. planticola infection is sometimes life-threatening. Hence, it is also important to use sufficiently strong antibiotics for an appropriate period. Although the optimal management of R. planticola infection in children has not been clearly established, we suggest that we can treat UTI caused by R. planticola mainly using first-generation cephalosporins.